Objectives: To provide the reader with information about the aetiology of spondylolysis and spondylolisthesis, and describe a new treatment approach that has been successful in treating these conditions. Data sources: A MEDLINE search was performed using the keywords ‘spondylolysis’, ‘spondylolisthesis’, and ‘low back pain’ for the years 1980–2000. Data synthesis: Spondylolysis is a very common cause of low back pain, and is characterized by the presence of a fatigue fracture of the pars interarticularis region of the vertebra. The mechanical design of the lumbar spine allows it to withstand the high forces that are placed on it. When these stresses are above the threshold that can be tolerated by the bone, a fatigue fracture results. Poor healing leads to instability of the pars interarticularis and eventually spondylolisthesis. Although this condition often develops in early adolescence, it is frequently undetected until adulthood. A thorough assessment of adolescents with low back pain may allow these fatigue fractures to heal properly, and prevent problems later in life. Recent emphasis on training the deep abdominal muscles has shown to be a more effective rehabilitation technique than traditional measures. Conclusions: Early detection and treatment is the key to successful rehabilitation of spondylolysis. Decreasing the offending activity while increasing the neuromuscular control of the deep abdominal muscles provides the best atmosphere for bony healing, and decreases the chance of future complications.